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Lump in throat shortness of breath


Lump in Throat: 7 Common Causes & How to Relieve it

The feeling of a lump in the throat is characterized by throat discomfort that in some cases can lead to difficulty breathing.

In most cases, this symptoms occurs due to a post-nasal drip, but it can also be a sign of more serious illnesses. Therefore, you should see a doctor if the sensation is very uncomfortable. 

The following is a list of common problems that can cause the sensation of a lump in the throat, as well as what you can do:

1. Stress and anxiety

Emotional reactions like stress and anxiety can cause a lump in the throat, nausea and vomiting, chest tightness, muscular tension and tremors.

How to relieve it: To alleviate this sensation when it is caused by anxiety, you should use relaxation techniques like yoga or mindfulness, and you should seek the assistance of a therapist. If your stress and anxiety symptoms are not relieved with relaxation techniques or with a therapist, you may need to complete treatment with anxiety medications, which should be prescribed by a psychiatry.

2. Gastroesophageal reflux disease (GERD)

GERD consists of the back-up of stomach content into the esophagus toward the mouth. It can cause pain, burning and inflammation, as well as a sensation of a lump in the throat. The intensity of symptoms depends on the acidity of the stomach contents, as well as the amount of acid in contact with esophageal tissue. Learn more about acid reflux and how it is treated.

How to relieve it: To reduce pain and discomfort in the throat caused by acid, treatment will usually consist of the use of proton pump inhibitors (medications that reduce stomach acid production) like omeprazole or pantoprazole. Antacids can also be prescribed, like aluminum hydroxide, magnesium hydroxide and sodium bicarbonate. Medications should be taken as prescribed by the doctor.

3. Thyroid problems

The thyroid gland is found in the neck, and therefore any pain in the area can be the result of a nodule or mass in the thyroid. This can alter the normal function of the thyroid gland.

How to relieve it: If your lump in the throat is related to thyroid problems, you should consult an endocrinologist, you can order testing to assess thyroid function and indicate appropriate treatment.

4. Swollen epiglottis

A swollen epiglottis, also known as laryngeal angioedema, can occur due to a serious allergic reaction. It is characterized by seve swelling of the throat, causing a lump in the throat as well as difficulty breathing. 

How to relieve it: If you experience swelling in the epiglottis, you should proceed immediately to the emergency room to prevent respiratory failure and death.

5. Myasthenia gravis

Myasthenia gravis is an illness that can cause many symptoms, including weakness in the neck muscles which make holding your head up straight difficult. This can cause your head to hang forward or to the side, which may sometimes cause a feeling of a lump in the throat.

How to relieve it: The treatment of myasthenia gravid consists of the use of medication that promote muscle control. Many times, the thymus must be surgically removed. This gland is associated with the immune system, and its removal can sometimes improve the quality of life of affected patients.

6. Myotonic dystrophy

Myotonic dystrophy is a genetic disease that is characterized by prolonged muscle contractions that have difficulty relaxing. The most affected muscles are those of the face, neck, hands, feet and back of the arms. It is possible for people with this illness to experience a lump in the throat. 

How to relieve it:  The treatment of myotonic dystrophy can include the use of medication like phenytoin, quinine, procainamide or nifedipine, which help to alleviate muscle rigidity and associated pain. Physiotherapy can also help to increase muscle strength.

7. Cancer

In more serious cases, a lump in the throat can be due to neck cancer, which is usually accompanied by other signs and symptoms like a palpable mass, hoarseness, difficulty swallowing, frequent choking, weight loss and general malaise.

How to relieve it: If the feeling of a lump in the throat is due to a tumor, the doctor should indicate treatment based on the stage of cancer and the health history of each individual patient.

Throat Lump: 7 Reasons to Worry

Have you been suffering from a persistent lump in your throat symptom? You might not be able to feel any lump on the outside of your neck but the obvious concern is that there might be a lump growing inside your throat. As a busy ENT specialist in Singapore, we see many patients who have been disturbed by a throat lump sensation, which can sometimes be associated with pain, fever, swallowing or breathing difficulties.

The Number One concern for patients is that this lump in throat symptom might be caused by underlying throat cancer growing inside….

Here are some “red flag” danger signs to watch out for, which should send you running to see your top ENT specialist in Singapore as soon as you can:

  1. Persistent or worsening throat lump sensation
  2. Swallowing difficulty, may have drooling of saliva at later stages (NOT a good sign!)
  3. Breathing difficulty or chest tightness
  4. Unilateral (more to one side of your throat)
  5. Associated fever
  6. Difficulty opening your mouth
  7. Earache or blocked ear symptoms
  8. Neck lump appearing on the outside

So what are the top causes of a persistent lump in throat sensation then? Having diagnosed and managed so many patients with throat issues in Singapore, Canada and the United Kingdom, here is what we look out for:

A) QUINSY (from Severe Tonsil Infection)

Figure 1: A quinsy presents as a large red swelling at the back of this patient’s throat on his right hand side (to the left of the picture).

What is a quinsy? A quinsy is the formation of pus or an abscess collecting around the severely infected tonsil. It occurs in more than 10% of tonsillitis cases and can happen to you for the very first time, even if you have never suffered a tonsil infection before! I have also seen it develop in healthy people who then go on to have their Covid-19 vaccination shots, leading to acute tonsillitis as a side effect. Quinsy formation is a well-recognised complication of severe tonsil infection, with the development of a peritonsillar abscess causing a large painful swelling on one side of your throat. Your tonsils are “golfball-sized” concentrations of lymph gland tissue and do play an important protective role in fighting infection particularly in young children. Tonsils tend to shrink in size and atrophy from the age of 5-8 years, so that most adults have very minimal tonsil tissue remaining, as other parts of their immune system mature and take over the dominant protective role in adulthood.

If you have difficulty opening your mouth/jaw, a painful enlarged swelling at the back of one side of your throat, with probably a fever and earache, then it’s a pretty good chance that you might be suffering from a quinsy. A quinsy needs to be drained as early as possible to prevent the spread of the abscess down to other parts of the throat, airway and neck. In very late severe cases, the quinsy swelling can cause airway obstruction with breathing and swallowing difficulties.

We drain quinsies under local anaesthesia to numb the back of the throat, and then start antibiotics, sometimes intravenous through a drip inserted into your arm, to treat the remaining infection. After you have recovered from your quinsy condition, the advice is to usually consider having your tonsils removed at a later stage to prevent a recurrence of the quinsy with subsequent tonsil infections in future.

B) TONGUE BASE CYST

Figure 2: The bulge of a large vallecular cyst is visible (arrow), just in front of the airway.

Sometimes, a lump in throat sensation may be due to the presence of a cyst growing behind the tongue. Such cysts are usually benign and are called mucous retention cysts, which contain a yellowish mucus liquid. We don’t really know the true cause of such cysts but if they become infected, then they may start to grow bigger. This can be investigated with a CT or MRI scan, with a view to removing it or draining it surgically if it is causing discomfort.

C) GASTRO-OESOPHAGEAL REFLUX

Acid refluxing upwards from the stomach may flow into the throat or oropharynx to cause recurrent inflammation and swelling of the mucosa (lining of the throat and airway). The may lead to muscle spasms of the throat, which if allowed to continue on a regular basis, may give rise to the feeling of a “lump in throat” without there actually being a lump in throat present. In some patients suffering from acid reflux, they may have a ring of muscle at the top of their food passage that is not able to close completely, hence allowing the backflow of acid upwards into their throat and airway. Other risk factors for acid reflux include smoking, alcohol, caffeine and stress. Interestingly, some patients do not suffer the “typical” symptoms of acid reflux like heartburn, and may instead just experience a persistent lump in throat problem, what we ENT specialists prefer to call “laryngo-pharyngeal reflux” (LPR).

A course of anti-acid medications is usually prescribed for a few weeks and sometimes, a referral to a gastroenterologist (stomach doctor) may be necessary to have a stomach endoscopy done. Urea breath testing may also be indicated to screen for a nasty bacteria called Helicobacter Pylori which can grow in your stomach to cause not only acid reflux, but also chronic severe gastritis, stomach ulcers and stomach cancer.

Figure 3: Helicobacter Pylori is a bacteria which lives in the stomach in some people, going on to cause gastritis, stomach ulcers and stomach cancer.

D) POSTNASAL DRIP

Could the lump in your throat feeling be something innocuous like a persistent backdrip of secretions from your nose? Yes, it’s quite possible as a chronic persistent flow of mucus from your nose and sinuses will cause further inflammation in your throat, giving rise to throat discomfort and a feeling of a lump in throat problem.

Figure 4: A postnasal drip means there is a constant flow of secretions or mucus from the back of your nose, down into your throat. This may be caused by a bad cold or the flu, sinus infections and/or nasal allergies.

This is actually a common leftover symptom after having suffered a bad bout of the flu or having just recovered from Covid-19 infection. Bear in mind, that just because your rapid antigen testing is now negative, does not mean that everything is fully recovered back to its normal settings before you caught the infection. It take a while sometimes, up to a few weeks, for things to go back to normal. Sometimes, viral infections may also affect sinus drainage pathways to lead to a buildup of trapped mucus and hence increasing the risk of sinus infections. This in turn will worsen any backdrip or postnasal drip inside your nose and throat.

Your friendly ENT specialist in Singapore should be able to diagnose straight away if it is the backdrip from your nose and sinuses causing the throat lump sensation, just be performing a simple, quick and painless test in the form of nasoendoscopy. If confirmed to be the cause of your throat discomfort, then nasal medications, usually a seasalt douche, nasal steroids, antihistamines and/or antibiotics should do the trick.

E) THROAT CANCER

Figure 5: A nasty irregular lump covered in white secretions is seen blocking the back of this patient’s throat. Biopsies revealed it to be due to squamous cell cancer of the soft palate and tonsil.

Throat cancers are occasionally detected as a cause of a persistent lump in throat sensation, more commonly occurring in smokers and heavy drinkers. However, there is another type of throat cancer which can also present as a tonsil tumour or a tongue base tumour: Such throat cancers caused by Human Papilloma Virus (HPV) have nothing to do with smoking or alcohol and tend to be found instead in nonsmokers. Some strains of HPV are linked to the development of head and neck cancers, in addition to cervical cancer in women.

As with all sorts of cancers, early detection and treatment is important in throat cancer to ensure a good prognosis and outcome. Incidentally, HPV-related throat cancers are associated with a much better outcome if detected early, compared to non-HPV throat cancers associated with smoking.

F) HYPOTHYROIDISM

When your thyroid gland is not producing enough thyroid hormone, then you will suffer the effects of hypothyroidism i.e. an underactive thyroid. The thyroid gland is a very important gland whose thyroid hormones are responsible for the well-being of practically every part of your body, including your heart and metabolism.

Common symptoms and signs of hypothyroidism include feeling tired, weight gain, dry hair and skin, constipation, but sometimes, people may also experience a lump in throat symptom if they suffer from hypothyroidism. A simple blood test can be done to screen for this and if indicated, then a course of thyroid medication is prescribed to replenish the insufficient thyroid hormone levels to help you feel better.

G) GLOBUS PHARYNGEUS

If you have been screened carefully for the above conditions by your top ENT specialist in Singapore, and the examination is still normal, then sometimes, the symptoms of a lump in throat sensation may be due to a benign condition called Globus pharyngeus. Its old name was Globus hystericus but is now more appropriately termed Globus pharyngeus, a non-cancerous condition of the throat muscles which keep going into spasms and tightening up, giving rise to the feeling of your throat “closing up” and the sensation of “a lump in throat”. However, globus pharyngeus is a diagnosis of exclusion, meaning that we should only arrive at this conclusion after having already carefully ruled out all other pathological conditions. The key difference is that Globus pharyngeus is usually intermittent and often relieved by eating. It is NOT made worse by eating or drinking. Risk factors include underlying acid reflux irritating the throat muscles, as well as stress and anxiety which can lead to increased muscle tightness and spasmodic episodes.

Of course, if you’re still concerned about your lump in throat sensation, then the best way to set your mind at ease, is to visit your friendly ENT specialist in Singapore!

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Tags: Difficulty breathing, Difficulty swallowing, sinusitis, Sore throat, throat cancer, Throat Lump, Throat pain, Thyroid, Tonsil infection

Lump in the throat - the causes of occurrence, in what diseases it occurs, diagnosis and methods of treatment

Diabetes mellitus

Angina

Tonsillitis

Epiglottitis

Pharyngitis

Diffuse goiter

Thyroiditis

Tumor

Esophageal dyskinesia

2276 12 December

The sensation of a lump in the throat is not uncommon. Many have experienced this painless but uncomfortable condition at least once in their lives. In medical literature, it is referred to as the pharyngeal ball. In most cases, this symptom is not associated with serious diseases, however, an accurate answer can only be obtained after consulting a specialist, because there are a number of diseases that may be accompanied by a sensation of a foreign body in the throat.

Varieties

There is no generally accepted classification. It all depends on the reason that caused this condition.

Possible causes of sensation of a lump in the throat

Patients complaining of a lump in the throat can be divided into two groups: in some, this condition occurs due to neuropsychiatric disorders, while in others, the cause lies in somatic, that is, diseases directly related to internal organs.

Often, a feeling of a lump in the throat appears in people who are easily excitable, sensitive to stress and emotional upheavals. A lump in the throat has long been described by doctors as a symptom of a neurotic disorder, more often occurring in young women. However, at present, this condition occurs with equal frequency in people of both sexes.

If the feeling of a lump in the throat is constant and persists for several weeks, then first of all it is necessary to exclude oncopathology. This may be a malignant or benign process in the larynx, esophagus or other organs of the neck, causing compression of surrounding tissues. Particular attention should be shown if the patient complains of pain in the neck or when swallowing, fatigue, loss of appetite and body weight.

Infectious and inflammatory diseases of the ENT organs can also cause a pharyngeal ball.

Very often the sensation of a lump in the throat is associated with diseases of the gastrointestinal tract.

It is necessary to find out if the patient has symptoms such as heartburn, cough, sour belching, stomach pain and a feeling of heaviness after eating.

The sensation of a foreign body in the throat can be caused by thyroid disease. An increase in the volume of the gland is more often associated with a lack of iodine in the diet or with an autoimmune lesion (autoimmune thyroiditis).

Sometimes the feeling of a lump in the throat is caused by a decrease and even complete cessation of salivation.

This condition can occur in patients with diabetes mellitus, in women in menopause, with systemic autoimmune diseases.

Enlarged lymph nodes in the neck can also lead to discomfort and a sensation of a lump in the throat.

Difficulty in swallowing can sometimes occur due to osteochondrosis of the cervical spine. In this case, a person may be disturbed by headache, dizziness, pain in the neck, back, stiffness of movements.

Do not forget about the possible role of traumatic effects on tissues. Endoscopic examinations and even eating rough food can contribute to the appearance of discomfort in the throat.

Sensation of a lump in the throat is mainly accompanied by:

  1. Diseases of the upper respiratory tract (tonsillitis, tonsillitis, epiglottitis, pharyngitis).
  2. Diseases of the thyroid gland (endemic goiter, diffuse toxic goiter, autoimmune thyroiditis).
  3. Neoplasms in the neck.
  4. Osteochondrosis of the cervical spine.
  5. Gastroesophageal reflux disease (GERD).
  6. Esophageal dyskinesia.
  7. Heterotopia of the gastric mucosa.
  8. Diseases of the endocrine system (diabetes mellitus, hormonal disorders).
  9. Systemic autoimmune diseases (scleroderma, Sjögren's syndrome).
  10. Psychological factors, stress.

Which doctors to contact a general practitioner who, after examination, will be able to refer the patient to a narrow specialist, such as:

  • gastroenterologist;
  • otorhinolaryngologist;
  • endocrinologist;
  • oncologist;
  • neurologist;
  • psychotherapist.

Diagnosis

To clarify the diagnosis, the doctor may prescribe the following types of examination:

  1. Gastroscopy (esophagogastroduodenoscopy, endoscopy) for suspected gastroesophageal disease and esophageal dyskinesia.
  2. Ultrasound of the thyroid gland, blood test for thyroid hormones.

Thyroid: screening

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  1. X-ray of the cervical spine.
  2. Culture of upper respiratory tract discharge for microflora, determination of sensitivity to antimicrobial drugs and bacteriophages (in case of an infectious process, sputum culture and scraping of epithelial cells of the oropharynx may be required to identify the pathogen in order to prescribe adequate antibiotic therapy).

Culture of the upper respiratory tract for microflora, determination of sensitivity to antimicrobial drugs and bacteriophages (Upper Respiratory Culture, Routine. Bacteria Identification. Antibiotic Susceptibility and Bacteriophage Efficiency testing)

Synonyms: Upper Respiratory Culture, Routine. Bacteria Identification. Antibiotic Susceptibility and Bacteriophage Efficiency testing. Brief description of the study "Sowing the discharge of the upper respiratory tract on ...

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Careful collection of anamnesis (history of the disease), taking into account the patient's complaints, examination and additional research will help the doctor make the correct diagnosis.

Treatment

Based on the cause of the sensation of a lump in the throat, the doctor will prescribe the appropriate treatment. If the cause is psycho-emotional disorders, it is necessary to eliminate the traumatic factor, reduce stress at home and at work. You may need pharmacological therapy and consultations with a psychotherapist.

In case of diagnosing gastroesophageal reflux disease, a gastroenterologist will give recommendations on correcting the diet and diet, prescribe antacids to reduce stomach acidity and proton pump inhibitors that suppress the secretory function of the stomach.

In case of infection of the upper respiratory tract, an otorhinolaryngologist may prescribe local anti-inflammatory, antiseptic therapy and antibacterial drugs.

In case of thyroid diseases, an endocrinologist may recommend hormonal therapy, and in some cases, surgery.

What to do if you feel a lump in your throat

If the sensation of a lump in your throat is caused by stress, try to calm down. Drinking plenty of water can improve the condition.

Do not smoke, talk loudly, shout.

If the cause is gastroesophageal reflux disease, do not lie down immediately after eating.

Do not overeat, try to stick to fractional nutrition; The last meal should be 3 hours before bedtime.

Do not wear tight clothing and tight belts, corsets, bandages, leading to an increase in intra-abdominal pressure. Stop smoking and drinking alcohol.

Sources:

  1. Clinical guidelines "Acute tonsillitis and pharyngitis (Acute tonsillopharyngitis)". Developed by: National Medical Association of Otorhinolaryngologists, Interregional Public Organization "Alliance of Clinical Chemotherapists and Microbiologists", Union of Pediatricians of Russia, Interregional Association for Clinical Microbiology and Antimicrobial Chemotherapy, Euro-Asian Society for Infectious Diseases. – 2021.
  2. Clinical guidelines "Acute obstructive laryngitis [croup] and epiglottitis". Developed by: Union of Pediatricians of Russia, Interregional Association for Clinical Microbiology and Antimicrobial Chemotherapy, National Medical Association of Otorhinolaryngologists. – 2021.

IMPORTANT!

The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.
For a correct assessment of the results of your analyzes over time, it is preferable to do studies in the same laboratory, since different laboratories may use different research methods and units of measurement to perform the same analyzes.


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Lump in the throat with neurosis, what to do?

A lump in the throat in case of neurosis is the first signal that malfunctions occur in the functioning of the nervous system. Patients who have problems with swallowing and sore throat seek help from many specialists (therapist, laryngologist), but few of them associate these symptoms with psychosomatics. By "neurosis of the pharynx" or "faringoneurosis" is meant a pathology that captures the funnel-shaped canal. It is the connecting anatomical link between the mouth and the esophagus.

Main symptoms of the disease:

  • Sore throat and throat.
  • Rumbling in the region of the neck.
  • Causeless cough.
  • Sensation of a coma.
  • Hoarseness of voice.
  • Imaginary swelling of the neck. Patients often feel the neck, look for various “bumps” and thickenings on it.

All symptoms tend to disappear quickly, the person gradually calms down and the feeling of discomfort disappears.

Treatment must necessarily be complex and based on the clinical symptoms of neurosis. With the help of a neurologist, it is possible to remove psychological blocks in stages. The doctor teaches the patient: to relax even in stressful situations, not to succumb to panic attacks; focus on positive things, keep nerves under control.

Physiotherapeutic procedures will help to normalize the state of a person with neurosis of the pharynx:

  • Electrophoresis with vitamins.
  • Therapeutic gymnastics (including breathing).
  • Therapeutic shower (Charcot, contrast).
  • Neck and collar area massage.

As a prevention of "neurosis of the throat, pharynx", use the following daily methods: